Tone Kristin Omsland

• Grefslie, Marianne Rørholt; Håberg, Siri Eldevik; Magnus, Maria Christine; Omsland, Tone Kristin & Magnus, Per Minor (2026). Parental asthma and childhood asthma phenotypes: maternal associations with persistent asthma. BMJ Open Respiratory Research. 13(1). doi: 10.1136/bmjresp-2026-004245. Full text in Research Archive Show summary

  Background: Maternal asthma has been more strongly associated with asthma in offspring than paternal asthma, but the influence of parental asthma on distinct asthma phenotypes remains unclear. Methods: We studied 16 055 children from the Norwegian Mother, Father and Child Cohort Study (MoBa). Parental asthma was reported at recruitment and classified as no parental asthma (reference), maternal asthma only, paternal asthma only or both parents with asthma. Offspring asthma was assessed at ages 3, 7 and 14 years through questionnaire-based parental reports, and four phenotypes were defined: never asthma, early-onset transient, early-onset persistent and late-onset asthma. Logistic regression was used to estimate associations between parental asthma status and offspring phenotypes, adjusting for sociodemographic, lifestyle and atopic factors, including atopic eczema and pollen/hay fever. Results: Offspring asthma phenotypes were distributed as follows: never asthma 88.8%, early-onset transient asthma 3.3%, early-onset persistent asthma 2.7% and late-onset asthma 5.2%. Maternal asthma was associated with increased odds of all offspring asthma phenotypes: early-onset transient asthma (OR 2.09, 95% CI 1.52 to 2.88), early-onset persistent asthma (OR 3.47, 95% CI 2.56 to 4.71) and late-onset asthma (OR 2.18, 95% CI 1.69 to 2.81). Paternal asthma showed similar associations, although point estimates were generally smaller: early-onset transient asthma (OR 2.01, 95% CI 1.48 to 2.73), early-onset persistent asthma (OR 2.49, 95% CI 1.81 to 3.44) and late-onset asthma (OR 1.85, 95% CI 1.44 to 2.38). Asthma in both parents was most strongly associated with early-onset persistent asthma (OR 5.34, 95% CI 2.86 to 9.98), whereas associations with early-onset transient and late-onset asthma were smaller and accompanied by wider CIs. The overall pattern of associations was similar across analyses stratified by parental atopy. Conclusions: Associations with maternal asthma were more pronounced than those with paternal asthma, particularly for early-onset persistent and late-onset phenotypes, although CIs overlapped for most comparisons. In contrast, early-onset transient asthma showed less differentiation by parental asthma status.

• Eilertsen, Maja; Czajkowski, Nikolai Olavi; Omsland, Tone Kristin; Røysamb, Espen & Nes, Ragnhild Bang (2026). Wellbeing, mastery and work participation: Effects of the Five Ways to Wellbeing course—a randomized controlled trial. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948261479465. Full text in Research Archive Show summary

  Background: Rising ill health, declining wellbeing, and absenteeism threaten societal sustainability amid an ageing population. Promoting health, wellbeing and work participation is essential. The Five Ways to Wellbeing course is a six-week programme designed to enhance wellbeing through five core activities: connecting, being active, taking notice, learning, and giving. A digital, shorter version has shown effectiveness in the general population, but the physical course has not been evaluated by randomized controlled trial in high-risk groups. Methods: This parallel two-group randomized controlled trial examined the effects of the Five Ways to Wellbeing course versus no course. Adults (⩾18 years old) receiving benefits through the Norwegian Labour and Welfare Administration were randomly assigned to the intervention or control group. The trial was non-blinded; participants were aware of group allocation because blinding was not feasible. Main outcomes were wellbeing, mastery and work participation, measured at baseline, post-intervention and six months. Multilevel analyses compared repeated measures across groups. Results: A total of 171 adults were randomized to the intervention (n = 87) or the control group (n = 84). Owing to attrition, data from 71 intervention and 46 control participants were included in the final analyses. No statistically significant differences in wellbeing, mastery or work participation were observed between groups. Conclusions: This underpowered trial found no statistically significant effects, limiting conclusions about the course’s effectiveness. However, it provides insight into the challenges of conducting pragmatic randomized trials within routine welfare services.

• Eilertsen, Maja; Czajkowski, Nikolai Olavi; Røysamb, Espen; Omsland, Tone Kristin; Prydz, Monica Beer & Blom, Ellen Eimhjellen [Show all 7 contributors for this article] (2026). Changes in Wellbeing, Social Connection, and Health following Participation in the Five Ways to Wellbeing Course: A Non-Randomized, Longitudinal, Quasi-Experimental Study in Help-Seeking Participants. International Journal of Applied Positive Psychology. ISSN 2364-5040. 11. doi: 10.1007/s41042-025-00271-9. Full text in Research Archive Show summary

  Society faces a growing burden of preventable health-related issues, highlighting the need for effective interventions that promote health and prevent illness, particularly among high-risk groups. The Five Ways to Wellbeing course is a 6-week intervention designed to enhance wellbeing and health by encouraging participants to practice five key activities: connect, be active, take notice, keep learning, and give. This study assessed changes in wellbeing, social connection, and health among participants facing physical and mental health challenges, following participation in the Five Ways to Wellbeing course, using a non-randomized, longitudinal, quasi-experimental design. A total of 373 adults who participated in the Five Ways to Wellbeing course were assessed at baseline, immediately after the intervention, and at 6- and 15-months post-intervention. Wellbeing, social connection, and physical and mental health were measured using validated questionnaires. A non-randomized comparison group (n = 923) from a separate study was included, as randomization was not possible. Changes over time and between groups were analyzed using paired t-tests and multilevel models. Participants reported significant improvements in wellbeing and social connection, sustained at 6 and 15 months (Cohen’s d = 0.21–0.63). Improvements in mental health were greater than in the comparison group, with statistically significant time-by-group interaction effects (p = 0.012 at post-test; p = 0.002 at 15 months). Improvements in physical health were comparable between groups (p = 0.206 and p = 0.107). The Five Ways to Wellbeing course may offer a promising approach to improving short- and long-term wellbeing, social connection, and subjective health in a group of vulnerable participants seeking to improve their health.

• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2026). Incidence of proximal humerus fracture among older adults in Oslo, Norway varies by country background, marital status, and season. Osteoporosis International. ISSN 0937-941X. p. 1–11. doi: 10.1007/s00198-026-07909-7. Full text in Research Archive Show summary

  Purpose The incidence, sociodemographic risk factors, and injury circumstances of proximal humerus fractures (hereafter called humerus fractures) remain insufficiently investigated. We aimed to examine variation in humerus fracture risk by age, sex, marital status, education, and country background, and to describe injury location and seasonal distribution of humerus fractures. Methods In this register-based cohort study, humerus fractures sustained 2012–2022 in individuals born < 1952 living in Oslo were identified from the Norwegian Patient Registry. Information on country background, marital status, and education was obtained from Statistics Norway. Incidence rate ratios (IRRs) were estimated by Poisson regression and age-standardized incidence rates (in individuals ≥ 70 years) were calculated. Results Based on 3,520 humerus fractures (79% women) among 100,982 individuals, incidence rates were 62 (95% CI 59, 64) and 22 (95% CI 20, 24) per 10,000 person years in women and men, respectively, and increased substantially with age. Humerus fracture risk was lower in all country background categories compared to Norway (reference), with the lowest risk observed for the category mainly including individuals from Asia/Africa: IRR 0.49 (95% CI 0.38, 0.65) in women and IRR 0.37 (95% CI 0.24, 0.57) in men. An IRR of 1.17 (95% CI 1.03, 1.33) was found in unmarried compared to married women, with a corresponding IRR of 1.70 (95% CI 1.37, 2.11) in unmarried versus married men. Humerus fracture numbers peaked during winter. Conclusions Having Norwegian background and being unmarried carried the highest humerus fracture risk. Identifying vulnerable high-risk groups is important when planning future healthcare services.

• Johansen, Marius; Omsland, Tone Kristin; Laine, Katariina; Håberg, Siri Eldevik & Magnus, Maria Christine (2026). Risk of postpartum depression among women with endometriosis: the Norwegian mother, father and child cohort study (MoBa). European Journal of Epidemiology (EJE). ISSN 0393-2990. 41, p. 197–206. doi: 10.1007/s10654-025-01338-2. Full text in Research Archive Show summary

  Women with endometriosis have a higher burden of anxiety and depression. Whether they are at increased risk of postpartum depression (PPD) remains unclear. We aimed to compare the risk of PPD between women with and without endometriosis and to explore mediation by previous history of major depression and infertility. In a population-based cohort study, we compared 1,159 singleton pregnancies to women with self-reported endometriosis and 74,590 pregnancies to women without endometriosis. We calculated a djusted risk ratios (aRR) with 95% confidence intervals (CI) using multivariable log-binomial regression, adjusting for age, body mass index, education and income. Mediation analyses assessed the indirect effect of any history of major depression or infertility. Women with endometriosis had a higher risk of PPD (aRR: 1.34, 95% CI: 1.15–1.55). Mediation analyses indicated that a large part of this association was explained by a higher lifetime prevalence of major depression among women with endometriosis (natural direct effect of endometriosis: aRR: 1.17, 95% CI: 1.00-1.36; natural indirect effect of any history of major depression: aRR: 1.14, 95% CI: 1.08–1.20), with 49.3% proportion mediated. Infertility demonstrated a negative natural indirect effect on the association between endometriosis and PPD (aRR: 0.87, 95% CI: 0.81–0.94). Women with endometriosis had an elevated risk of PPD which was largely explained by a higher lifetime prevalence of major depression. Our findings suggest that they constitute a high-risk group and could benefit from closer follow-up to facilitate early identification and intervention.

• Grefslie, Marianne Rørholt; Håberg, Siri Eldevik; Magnus, Maria Christine; Omsland, Tone Kristin & Magnus, Per Minor (2026). Parental asthma and risk of offspring asthma from childhood to adolescence: a population-based cohort study. BMJ Open Respiratory Research. 13(1). doi: 10.1136/bmjresp-2025-003608. Full text in Research Archive Show summary

  Background Maternal asthma has been associated with a higher risk of asthma in early childhood compared with paternal asthma, but it is unclear whether this difference persists into adolescence. Methods We analysed 55 643 children from the Norwegian Mother, Father and Child Cohort Study. Parental asthma was self-reported during pregnancy; offspring asthma was reported by mothers at ages 3, 7 and 14 years. Logistic regression models estimated associations between parental asthma and offspring asthma at each age, adjusting for maternal age, parental prepregnancy body mass index, parental education, parental smoking and parental atopic conditions, including atopic eczema and pollen/hay fever. Results Asthma prevalence among offspring was 6.5% at age 3, 5.2% at age 7 and 5.4% at age 14. Compared with children of non-asthmatic parents, adjusted ORs for asthma at age 3 were 3.11 (95% CI 2.73 to 3.54) for maternal asthma only and 2.25 (95% CI 1.97 to 2.56) for paternal asthma only. Similar patterns were observed at ages 7 (maternal OR 2.96 (95% CI 2.54 to 3.45); paternal OR 2.36 (95% CI 2.03 to 2.75)) and 14 (maternal OR 3.03 (95% CI 2.46 to 3.73); paternal OR 1.95 (95% CI 1.57 to 2.43)). At age 3, maternal asthma was associated with higher odds in boys (OR 3.30) than girls (OR 2.82), and higher absolute risk (19.2% vs 12.2%). However, interaction tests by offspring sex were not statistically significant. Conclusions Maternal asthma conferred a consistently stronger risk of offspring asthma than paternal asthma, from early childhood into adolescence. This effect appeared slightly stronger in boys in early childhood, though sex differences were not statistically significant.

• Bjørnerem, Åshild Marit; Khoshkhabari, Jashar; Hansen, Ann Kristin; Borgen, Tove Tveitan; Frihagen, Frede & Solberg, Lene Bergendal [Show all 8 contributors for this article] (2025). Adherence to secondary fracture prevention is associated with reduced risk of subsequent fractures. Osteoporosis International. ISSN 0937-941X. 36(11), p. 2263–2272. doi: 10.1007/s00198-025-07697-6. Full text in Research Archive
• Ally, Mwashungi M.; Kakoko, Deodatus Conatus; Omsland, Tone Kristin; Swai, Calvin; Metta, Emmy & Moen, Kåre [Show all 12 contributors for this article] (2025). Level of Healthcare Facility and Psychosocial Factors Influence Perceived Self-Efficacy for Appropriate Use of Hydroxyurea: Experience from Caregivers of Children with Sickle Cell Disease in Tanzania. Healthcare. 13(13), p. 1500–1500. doi: 10.3390/healthcare13131500. Full text in Research Archive Show summary

  Background: Sickle cell disease (SCD) is associated with high physical and psychosocial burden among patients and their families. Hydroxyurea (HU) improves health-related quality of life by preventing SCD complications. Despite its availability, HU is underutilised in Tanzania. Perceived self-efficacy for appropriate medication use influences medication usage among individuals with chronic illnesses. We studied factors associated with caregivers’ perceived self-efficacy for appropriate use of HU and its association with HU usage among children with SCD in Dar-es-Salaam. Methods: We conducted a cross-sectional study from May to August 2023. We enrolled 374 caregivers of children with SCD from two regional and two national hospitals. We adapted the self-efficacy for appropriate medication use scale, a multidimensional perceived social support scale, and a patient health questionnaire for assessment of self-efficacy, social support, and depressive symptoms, respectively. Results: Three-quarters of caregivers had high perceived self-efficacy scores for medication use. Attending national hospitals, high social support, and absence of depressive symptoms were positively associated with perceived self-efficacy (adjusted beta coefficient aβ 2.3, 95% CI 0.5–4.2; aβ 9, 95% CI 7.1–10.9; and aβ 5.3, 95% CI 2.8–7.8, respectively). Caregivers with high self-efficacy were 5.3 times more likely to give HU to their children compared with those with low self-efficacy (incidence rate ratio 5.3, 95% CI 3.3–8.3). Conclusions: Hospital levels and psychosocial factors influence caregivers’ perceived self-efficacy for appropriate HU use. We recommend targeted interventions to enhance psychosocial support among caregivers to increase caregivers’ perceived self-efficacy and HU utilization among children with SCD in Tanzania.

• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 21 contributors for this article] (2025). Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporosis International. ISSN 0937-941X. 36(3), p. 501–512. doi: 10.1007/s00198-024-07376-y. Full text in Research Archive Show summary

  Summary Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures. Purpose Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality. Methods The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011–2015) or intervention period (2015–2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated. Results A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83–0.92) and 10% in men (HR 0.90, 95% CI 0.81–0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79–0.86) and 15% in men (HR 0.85, 95% CI 0.81–0.89). Conclusion A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

• Kjeldgaard, Helena Kames; Omsland, Tone Kristin; Skirbekk, Vegard Fykse; O’Flaherty, Martin; Meyer, Haakon Eduard & Holvik, Kristin (2025). Forecasting the burden of hip fracture in Norway towards 2050 by educational level: The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948251325760. Full text in Research Archive Show summary

  Aims: Hip fracture burden is expected to increase due to the ageing population. Given that hip fracture incidence differs by educational attainment, and that a shift in the older population’s educational level will manifest itself in coming decades, we investigated future hip fracture trends in Norway and their variation by attained educational level. Methods: Estimated annual hip fracture numbers in the population aged 50+ years in 2020–2050 were based on information from the Norwegian Epidemiologic Osteoporosis Studies hip fracture database and official population projections from Statistics Norway. Projected educational attainment was obtained from the Wittgenstein Centre for Demography and Global Human Capital. We explored two scenarios: first, assuming that the observed 2019 rates remain constant until 2050, and second, assuming a continuing rate of decline corresponding to that observed during 1999–2019. Results: The projections showed that the annual number of hip fractures will increase by 91% in women and 131% in men given constant sex- and age-specific rates, and by 27% in women and 66% in men given declining rates. The majority of hip fractures are expected in the group with secondary education, however, the numbers will increase steeply in people with tertiary education due to the temporal shift in educational attainment. Conclusions: The annual number of hip fractures may double by 2050, placing high demands on the healthcare services. The majority of hip fractures are projected to occur in people with secondary and tertiary education. It is vital to intensify preventive efforts, not least in the high-risk populations.

• Lashkari, Reyhaneh; Dahl, Cecilie; Borgen, Tove Tveitan; Bjørnerem, Åshild Marit; Gjertsen, Jan-Erik & Wisløff, Torbjørn [Show all 13 contributors for this article] (2025). Distal forearm fracture risk in a cohort of female and male immigrants and Norwegian-born residents aged 20 to 79 years in Norway. Archives of Osteoporosis. ISSN 1862-3522. 20, p. 1–9. doi: 10.1007/s11657-025-01566-9. Full text in Research Archive Show summary

  Summary The study investigated the risk of distal forearm fractures in adult Norwegian residents according to regions of birth. There were significant differences in fracture risk between the region of birth categories. Although the magnitude of the rates was different between the birth categories, similar sex and seasonal risk patterns were observed. Introduction Worldwide, distal forearm fractures (DFFs) are the most common fractures in adults. This study compared incidence rates of first DFFs in women and men in Norway by region of birth, age, and season. Methods We included Norwegian residents aged 20 to 79 years with a first DFF between 2010 and 2020 using data from the Norwegian Patient Registry and population estimates from Statistics Norway. Three countries of birth groups were compared: Norwegian-born, Global North (most of Europe, North America, Australia, and New Zealand), and Global South (Asia, Africa, Latin America, Oceania). Results Compared to Norwegian-born residents in Norway, immigrants from Global North had 16% and 37% higher age-adjusted DFF incidence rates in women and men, respectively. Compared to Norwegian-born residents, female immigrants from Global South regions had 24% lower rates, whereas male immigrants from Global South regions did not have significantly lower rates. DFF rates were highest in winter for older men and women regardless of birth category, whereas rates in men younger than 50 years were highest during summer months. Conclusion We observed significant differences in DFF rates by sex, region of birth, age, and season. Our findings might have important implications for public health efforts and fracture prevention strategies. Nonetheless, further research is necessary to investigate the underlying risk factors and mechanisms driving these differences.

• Semsarian, Sepideh; Omsland, Tone Kristin; Heen, Espen Kolstad; Madar, Ahmed Ali; Frihagen, Frede & Gjertsen, Jan-Erik [Show all 14 contributors for this article] (2024). Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study. Archives of Osteoporosis. ISSN 1862-3522. 19(1), p. 1–10. doi: 10.1007/s11657-024-01419-x. Full text in Research Archive Show summary

  Summary: The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. Background: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. Methods: Nationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. Results: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men. Conclusion: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

• Riska, Brit Solvor Lyse; Gunnes, Nina; Finnes, Trine Elisabeth; Meyer, Haakon Eduard; Hoff, Mari & Omsland, Tone Kristin [Show all 7 contributors for this article] (2024). Risk of first hip fracture under treatment with zoledronic acid versus alendronate: a NOREPOS cohort study of 88,000 Norwegian men and women in outpatient care. Archives of Osteoporosis. ISSN 1862-3522. 19. doi: 10.1007/s11657-024-01458-4. Full text in Research Archive Show summary

  We aimed to investigate the risk of hip fracture associated with zoledronic acid treatment compared to alendronate on a population level. The risk of hip fracture was lower in women using zoledronic acid and higher in women who had discontinued treatment. The findings support the effectiveness of intravenous bisphosphonate. Purpose: To investigate whether zoledronic acid (ZOL) was associated with a lower risk of the first hip fracture than alendronate (ALN) in Norway using real-world data. Methods: Nationwide data on drugs dispensed in outpatient pharmacies were individually linked with all hospital-treated hip fractures. Individuals aged 50-89 years without previous hip fracture were included at their first filling of a prescription for ALN or ZOL during 2005-2016. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) for first hip fracture by time-varying exposure to ZOL versus ALN were estimated in sex-stratified flexible parametric survival analyses. Covariates included time-varying accumulated ALN exposure and comorbidity level expressed by the prescription-based Rx-Risk Comorbidity Index, marital status, education, and residential urbanity. Results: Of 75,250 women who initiated treatment, 72,614 (96.5%) were exposed to ALN and 6366 (8.5%) to ZOL. Of 12,739 men who initiated treatment, 12,311 (96.6%) were exposed to ALN and 784 (6.2%) to ZOL. In women, the HR for first hip fracture was 0.75 (95% CI: 0.61-0.91) for ZOL versus ALN. In men, the corresponding HR was 0.59 (95% CI: 0.32-1.07). Discontinued treatment was associated with increased risk compared with current ALN treatment in women (HR: 1.33; 95% CI: 1.24-1.42, men: HR 1.13 (95% CI: 0.95-1.35)). Conclusions: In women, the risk of first hip fracture when treated with ZOL was 25% lower than when treated with ALN. Discontinued treatment was associated with a 33% increase in hip fracture risk. Similar, albeit statistically non-significant, results were observed in men. Keywords: Alendronate; Bisphosphonate; Hip fracture; Osteoporosis; Real-world data; Zoledronic acid.

• Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2024). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture - a nationwide NOREPOS cohort study. BMC Medicine. 22(1). doi: 10.1186/s12916-024-03335-w. Full text in Research Archive Show summary

  Background Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morbidity measured by the medication-based Rx-Risk Comorbidity Index (Rx-Risk) and the risk of first hip fracture. Methods Individual-level data on medications dispensed from pharmacies (2005–2016) was retrieved from the Norwegian Prescription Database and used to calculate Rx-Risk for each calendar year. Information on first hip fractures (2006–2017) was obtained from a nationwide hip fracture database. Individuals ≥ 51 years who filled at least one prescription during the study period comprised the population at risk. Using Rx-Risk as a time-varying exposure variable, relative risk estimates were obtained by a negative binomial model. Results During 2006–2017, 94,104 individuals sustained a first hip fracture. A higher Rx-Risk was associated with increased risk of hip fracture within all categories of age and sex. Women with the highest Rx-Risk (> 25) had a relative risk of 6.1 (95% confidence interval (CI): 5.4, 6.8) compared to women with Rx-Risk ≤ 0, whereas the corresponding relative risk in women with Rx-Risk 1–5 was 1.4 (95% CI: 1.3, 1.4). Similar results were found in men. Women > 80 years with Rx-Risk 21–25 had the highest incidence rate (514 (95% CI: 462, 566) per 10, 000 person years). The relative increase in hip fracture risk with higher Rx-Risk was most pronounced in the youngest patients aged 51–65 years. Conclusions Rx-Risk is a strong predictor of hip fracture in the general outpatient population and may be useful to identify individuals at risk in a clinical setting and in future studies.

• Holvik, Kristin; Dahl, Cecilie; Samuelsen, Sven Ove; Søgaard, Anne-Johanne; Solbakken, Siri Marie & Tell, Grethe Seppola [Show all 14 contributors for this article] (2024). Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporosis International. ISSN 0937-941X. 35, p. 2047–2053. doi: 10.1007/s00198-024-07133-1. Full text in Research Archive Show summary

  Summary: Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy. Purpose: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level. Methods: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002–2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression. Results: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders. Conclusions: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.

• Dahl, Cecilie; Ohm, Eyvind; Solbakken, Siri Marie; Anwar, Nudrat; Holvik, Kristin & Madsen, Christian [Show all 11 contributors for this article] (2023). Forearm fractures–are we counting them all? An attempt to identify and include the missing fractures treated in primary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(3), p. 247–256. doi: 10.1080/02813432.2023.2231028. Full text in Research Archive Show summary

  Objective: Norway has a high incidence of forearm fractures, however, the incidence rates based on secondary care registers can be underestimated, as some fractures are treated exclusively in primary care. We estimated the proportion of forearm fracture diagnoses registered exclusively in primary care and assessed the agreement between diagnosis for forearm fractures in primary and secondary care. <p> <p>Design: Quality assurance study combining nationwide data from 2008 to 2019 on forearm fractures registered in primary care (Norwegian Control and Payment of Health Reimbursement) and secondary care (the Norwegian Patient Registry).<p> <p>Setting and patients: Forearm fracture diagnoses in patients aged ≥20 treated in primary care (n = 83,357) were combined with injury diagnoses for in- and outpatients in secondary care (n = 3,294,336).<p> <p>Main outcome measures: Proportion of forearm fractures registered exclusively in primary care, and corresponding injury diagnoses for those registered in both primary and secondary care.<p> <p>Results: Of 189,105 forearm fracture registrations in primary and secondary care, 13,948 (7.4%) were registered exclusively in primary care. The proportion ranged from 4.9% to 13.5% on average between counties, but was higher in some municipalities (>30%). Of 66,747 primary care forearm fractures registered with a diagnosis in secondary care, 62% were incident forearm fractures, 28% follow-up controls, and 10% other fractures or non-fracture injuries.<p> <p>Conclusion: An overall small proportion of forearm fractures were registered only in primary care, but it was larger in some areas of Norway. Failing to include fractures exclusively treated in primary care could underestimate the incidence rates in these areas.

• Andreasen, Camilla; Dahl, Cecilie; Solberg, Lene Bergendal; Borgen, Tove Tveitan; Wisløff, Torbjørn & Gjertsen, Jan-Erik [Show all 13 contributors for this article] (2023). Epidemiology of forearm fractures in women and men in Norway 2008–2019. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-023-06990-6. Full text in Research Archive Show summary

  Summary The purpose of this paper is to describe rates of forearm fractures in adults in Norway 2008–2019. Incidence rate of distal forearm fractures declined over time in both sexes. Forearm fracture constitute a significant health burden and prevention strategies are needed. Purpose To assess age- and sex-specific incidence rates, and time trends for forearm fractures in Norway, and compare these with incidence rates in other Nordic countries. Methods Data on all patients aged 20–107 years with forearm fractures treated in Norwegian hospitals from 2008 to 2019 was retrieved from the Norwegian Patient Registry. Fractures were identified based on International Classification of Disease 10th revision code S52. Age- and sex-specific incidence rates and changes in incidence rates were calculated. Results We identified 181,784 forearm fractures in 45,628,418 person-years. Mean annual forearm fracture incidence rates per 100,000 person-years were 398 (95% CI 390–407) for all, 565 (95% CI 550–580) for women, and 231 (95% CI 228–234) for men above 20 years. Mean annual number of forearm fractures was 15,148 (95% CI 14,575–15,722). From 2008 to 2019, age-adjusted total incidence rates of forearm fractures S52 diagnoses declined by 3.5% (incidence rate ratio (IRR) of 0.997 (95% CI 0.994–0.999)) in men. The corresponding decline in women was not significant (IRR: 0.999 (95% CI 0.997–1.002)). In the same period, the age-adjusted incidence rates of distal forearm fractures declined by 7.0% in men (IRR = 0.930; 95% CI 0.886–0.965) and 4.7% in women (IRR = 0.953; 95% CI 0.919–0.976). The incidence rates of distal forearm fractures were similar to rates in Sweden and Finland. Conclusion Age-adjusted incidence rates of distal forearm fractures in both sexes declined over time.

• Omsland, Tone Kristin; Solberg, Lene Bergendal; Bjørnerem, Åshild Marit; Borgen, Tove Tveitan; Andreasen, Camilla & Wisløff, Torbjørn [Show all 23 contributors for this article] (2023). Validation of forearm fracture diagnoses in administrative patient registers. Archives of Osteoporosis. ISSN 1862-3522. 18(1), p. 1–9. doi: 10.1007/s11657-023-01322-x. Full text in Research Archive Show summary

  Summary The validity of forearm fracture diagnoses recorded in fve Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to defne forearm fractures in administrative data should depend on study purpose. Purpose In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to defne incident forearm fracture cases. Methods This hospital-based validation study included women and men aged≥19 years referred to fve hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard. Results Among the 8482 reviewed image reports and medical records, 624 patients were identifed with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8–92.6). The PPV increased from 73.9% (95% CI: 70.6–77.0) in crude data to 90.5% (95% CI: 88.0–92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%. Conclusion A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to defne cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the fndings are relevant to other fracture diagnoses and registers.

• Utheim, Mari Nythun; Isaakidis, Petros; Bergh, Rafael Van den; Géraud, Bantas Bata Ghislain; Mabvouna, Rodrigue Biguioh & Omsland, Tone Kristin [Show all 8 contributors for this article] (2023). Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study. Conflict and Health. 17(1). doi: 10.1186/s13031-023-00505-0. Full text in Research Archive Show summary

  Introduction In the Central African Republic (CAR), HIV/AIDS is the main cause of death in women aged 15–49 years. Increased testing coverage is essential in prevention of HIV/AIDS, especially in areas where conflict hinders access to health care. Socio-economic status (SES) has been shown to be associated with HIV testing uptake. We investigated whether “Provider-initiated HIV testing and counselling” (PITC) could be implemented in a family planning clinic in an active conflict zone in the Central African Republic to reach women of reproductive age and assessed whether socioeconomic status was associated with testing uptake. Methods Women aged 15–49 years were recruited from a free family planning clinic run by Médecins Sans Frontières in the capital Bangui. An asset-based measurement tool was created based on analysis of qualitative in-depth interviews. Measures of socioeconomic status were constructed from the tool, also by using factor analysis. Logistic regression was used to quantify the association between SES and HIV testing uptake (yes/no), while controlling for potential confounders: age, marital status, number of children, education level and head of household. Results A total of 1419 women were recruited during the study period, where 87.7% consented to HIV testing, and 95.5% consented to contraception use. A total of 11.9% had never been tested for HIV previously. Factors negatively associated with HIV testing uptake were: being married (OR = 0.4, 95% CI 0.3–0.5); living in a household headed by the husband as opposed to by another person (OR = 0.4, 95% CI 0.3–0.6), and lower age (OR = 0.96, 95% CI 0.93–0.99). Higher level of education (OR = 1.0, 95% CI 0.97–1.1) and having more children aged under 15 (OR = 0.92, 95% CI 0.81–1.1) was not associated with testing uptake. In multivariable regression, testing uptake was lower in the higher SES groups, but the differences were not significant (OR = 0.80, 95% CI 0.55–1.18). Conclusions The findings show that PITC can be successfully implemented in the patient flow in a family planning clinic, without compromising contraception uptake. Within the PITC framework in a conflict setting, socioeconomic status was not found to be associated with testing uptake in women of reproductive age.

• Riska, Brit Solvor Lyse; Gunnes, Nina; Stigum, Hein; Finnes, Trine E.; Meyer, Haakon E. & Omsland, Tone K. [Show all 7 contributors for this article] (2023). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporosis International. ISSN 0937-941X. 34(8), p. 1369–1379. doi: 10.1007/s00198-023-06752-4. Full text in Research Archive Show summary

  We investigated the association between bisphosphonate and denosumab use and risk of hip fracture in Norway. These drugs protect against fractures in clinical trials, but their population-level effect is unknown. Our results showed lowered risk of hip fracture for treated women. Treatment of high-risk individuals could prevent future hip fractures. Purpose To investigate whether bisphosphonates and denosumab reduced the risk of first-time hip fracture in Norwegian women when adjusting for a medication-based comorbidity index. Methods Norwegian women aged 50–89 in 2005–2016 were included. The Norwegian prescription database (NorPD) supplied data on exposures to bisphosphonates, denosumab, and other drugs for the calculation of the Rx-Risk Comorbidity Index. Information on all hip fractures treated in hospitals in Norway was available. Flexible parametric survival analysis was used with age as time scale and with time-varying exposure to bisphosphonates and denosumab. Individuals were followed until hip fracture or censoring (death, emigration, age 90 years), or 31 December 2016, whichever occurred first. Rx-Risk score was included as a time-varying covariate. Other covariates were marital status, education, and time-varying use of bisphosphonates or denosumab with other indications than osteoporosis. Results Of 1,044,661 women 77,755 (7.2%) were ever-exposed to bisphosphonate and 4483 (0.4%) to denosumab. The fully adjusted hazard ratios (HR) were 0.95 (95% confidence interval (CI): 0.91–0.99) for bisphosphonate use and 0.60 (95% CI: 0.47–0.76) for denosumab use. Bisphosphonate treatment gave a significantly reduced risk of hip fracture compared with the population after 3 years and denosumab after 6 months. Fracture risk was lowest in denosumab users who had previously used bisphosphonate: HR 0.42 (95% CI: 0.29–0.61) compared with the unexposed population. Conclusions In population-wide real-world data, women exposed to bisphosphonates and denosumab had a lower hip fracture risk than the unexposed population after adjusting for comorbidity. Treatment duration and treatment history impacted fracture risk.

• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Tunheim, Ketil & Stigum, Hein [Show all 8 contributors for this article] (2022). The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway - A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. Journal of Bone and Mineral Research. ISSN 0884-0431. 37(8), p. 1527–1536. doi: 10.1002/jbmr.4628. Full text in Research Archive Show summary

  Norway is an elongated country with large variations in climate and duration of winter season. It is also a high-risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (ICD-10 code S52) and hospitalized hip fractures (ICD-10 codes S72.0-S72.2) from 2008-2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008-2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (Incidence Rate Ratios (IRR), 95% Confidence Intervals (CI)) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (Hazard ratios (HR), 95% CI) were used to estimate the association between temperature and post hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from -20.2°C to 22.0°C, with a median of -2.0°C in winter and 14.4°C in summer. At low temperatures (

• Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon E; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Increased mortality in hip fracture patients living alone: A NOREPOS study. Journal of Bone and Mineral Research. ISSN 0884-0431. 36(3), p. 480–488. doi: 10.1002/jbmr.4212. Full text in Research Archive Show summary

  Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29—1.44; HR women = 1.23, 95% CI 1.18—1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25—6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population.

• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Tell, Grethe S. & Holvik, Kristin [Show all 7 contributors for this article] (2020). Contribution of elevation and residential proximity to the coast in explaining geographic variations in hip fracture incidence. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) study. Osteoporosis International. ISSN 0937-941X. p. 1–6. doi: 10.1007/s00198-020-05736-y. Full text in Research Archive
• Aamodt, Geir; Renolen, Ranveig; Omsland, Tone Kristin; Meyer, Haakon E; Rabanal, Kjersti Stormark & Søgaard, Anne-Johanne (2020). Ethnic differences in risk of hip fracture in Norway: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. p. 1587–1592. doi: 10.1007/s00198-020-05390-4. Full text in Research Archive
• Carlsen, Ellen Øen; Magnus, Maria Christine; Omsland, Tone Kristin; Magnus, Per; Håberg, Siri Eldevik & Wilcox, Allen J. (2020). Stumped by the Hump: The Curious Rise and Fall of Norwegian Birthweights, 1991–2007. Epidemiology. ISSN 1044-3983. 31(4), p. 587–594. doi: 10.1097/EDE.0000000000001211. Full text in Research Archive
• Forsén, Lisa; Søgaard, Anne-Johanne; Holvik, Kristin; Meyer, Haakon E; Omsland, T.K. & Stigum, Hein [Show all 7 contributors for this article] (2020). Geographic variations in hip fracture incidence in a high-risk country stretching into the Arctic: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 31(7), p. 1323–1331. doi: 10.1007/s00198-020-05346-8. Full text in Research Archive Show summary

  Summary There are geographic variations in hip fracture incidence rates across Norway, with a lower incidence in the coastal areas of the southwest and in the Arctic north, contrary to what may be expected with regard to vitamin D exposure from sunlight. The regional differences have become smaller in recent years. Introduction To investigate geographic variation in hip fracture incidence within Norway and regional differences in time trends. Methods All hip fractures treated in Norwegian hospitals 2002–2013 were included, and demographic information was obtained from Statistics Norway. Age-standardized incidence rates were calculated separately for 19 counties. Incidence rate ratios with 95% confidence intervals for county differences and time trends were estimated using Poisson regression. Results Age-standardized number of hip fractures per 10,000 person-years varied between counties from 69 to 84 in women and from 34 to 41 in men. The highest rates were observed in the southeastern capital city of Oslo, while rates were low in the four northernmost counties. There was an east-west gradient, with lower incidence in the coastal southwest compared with the southeast. Women showed a statistically significant decline during 2002–2013 in almost all counties (up to 31%). In men, only a few counties showed a decline. In both genders, hip fracture rates at age 80 in the combined five counties with the highest rates were significantly higher than in the combined five counties with the lowest rates across the period, although the trends converged over time. Conclusions In Norway, the hip fracture incidence was lower in the north compared with the south. In addition, we observed an east-west gradient with the highest incidence in the southeast and lower incidence in the coastal southwest. While there has been an overall declining trend in hip fracture incidence over time, regional differences are still apparent.

• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 19 contributors for this article] (2019). Post-Fracture Risk Assessment: Target The Centrally Sited Fractures First! A Substudy of NoFRACT. Journal of Bone and Mineral Research. ISSN 0884-0431. 34(11), p. 2036–2044. doi: 10.1002/jbmr.3827. Full text in Research Archive Show summary

  The location of osteoporotic fragility fractures adds crucial information to post-fracture risk estimation. Triaging patients according tofracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracturerisk. The objectives of this cross-sectional study were therefore to explore potential differences between central (vertebral, hip, proximalhumerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoralneck, total hip, and lumbar spine assessed using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS) calculated, con-comitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire con-cerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1-SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (allp< 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with centralfragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patientswith peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure,translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fractureprevention, although attention to peripheral fractures should still not be diminished.

• Hagen, Gunhild; Magnussen, Jon; Tell, Grethe Seppola & Omsland, Tone Kristin (2019). Estimating the future burden of hip fractures in Norway. A NOREPOS study. Bone. ISSN 8756-3282. 131:115156, p. 1–7. doi: 10.1016/j.bone.2019.115156. Full text in Research Archive Show summary

  Background The incidence rate of hip fractures seems to be declining in many western countries. However, due to the ageing of the population, the number of fractures may still be on the rise. No papers so far have quantified the future burden of hip fractures in terms of both health loss (as measured in disability adjusted life years DALY) and costs. The purpose of this paper is to assess the future health and economic burden of hip fractures. Methods We collected population projections from Statistics Norway up until the year 2040. The medium projection was used for the base case analysis. Fracture rates for 2008 were estimated based on information from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database (NORHip), which includes information about all hip fractures in Norway. Future fracture rate was assumed to decline by 0.7% per year in the base case. We used the same assumptions as the global burden of disease project on years of remaining life and disability weights. Cost of hip fracture was based on the published literature. In sensitivity analyses, we assessed the impact of changing underlying assumptions on demographic change, development in hip fracture rate, assumed life expectancy and choice of disability weights. Results Assuming a medium population growth and a continued decline in fracture rate, our estimates indicate that health lost to hip fractures will approximately double, from 32,850 DALYs in 2020 to 60,555 in 2040. Over the same period, costs are estimated to increase by 65%. Sensitivity analyses indicate that estimates are highly sensitive to assumptions on both population growth, fracture rate development, disability weights and assumed life expectancy. Conclusion The burden of hip fractures in terms of DALYs lost and cost incurred is likely to increase even if the fracture rate continues to decline.

• Holvik, Kristin; Meyer, Haakon E; Laake, Ida; Feskanich, Diane; Omsland, Tone Kristin & Søgaard, Anne-Johanne (2019). Milk drinking and risk of hip fracture: The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). British Journal of Nutrition. ISSN 0007-1145. 121(6), p. 709–718. doi: 10.1017/S0007114518003823. Full text in Research Archive Show summary

  Milk provides energy and nutrients considered protective for bone. Meta-analyses of cohort studies have found no clear association between milk drinking and risk of hip fracture, and results of recent studies are contradictory. We studied the association between milk drinking and hip fracture in Norway, which has a population characterised by high fracture incidence and a high Ca intake. Baseline data from two population-based cohorts were used: the third wave of the Norwegian Counties Study (1985–1988) and the Five Counties Study (2000–2002). Diet and lifestyle variables were self-reported through questionnaires. Height and weight were measured. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Of the 35 114 participants in the Norwegian Counties Study, 1865 suffered a hip fracture during 613 018 person-years of follow-up. In multivariable Cox regression, hazard ratios (HR) per daily glass of milk were 0·97 (95 % CI 0·92, 1·03) in men and 1·02 (95 % CI 0·96, 1·07) in women. Of 23 259 participants in the Five Counties Study, 1466 suffered a hip fracture during 252 996 person-years of follow-up. HR for hip fractures per daily glass of milk in multivariable Cox regression was 0·99 (95 % CI 0·92, 1·07) in men and 1·02 (95 % CI 0·97, 1·08) in women. In conclusion, there was no overall association between milk intake and risk of hip fracture in Norwegian men and women.

• Solbakken, Siri Marie; Magnus, Jeanette H.; Meyer, Haakon E; Dahl, Cecilie; Stigum, Hein & Søgaard, Anne-Johanne [Show all 14 contributors for this article] (2019). Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study. JBMR Plus. 3(11). doi: 10.1002/jbm4.10236. Full text in Research Archive Show summary

  Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 20 contributors for this article] (2019). High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT. Bone. ISSN 8756-3282. 122, p. 14–21. doi: 10.1016/j.bone.2019.02.008. Full text in Research Archive Show summary

  Purpose - Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures. Methods - This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire. Results - Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ −2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%. Conclusions - More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.

• Riska, Brit Solvor Lyse; Forsén, Lisa; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Meyer, Haakon E & Holvik, Kristin (2018). Does the Association of Comorbidity with 1-Year Mortality After Hip Fracture Differ According to Gender? The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Journal of The American Geriatrics Society. ISSN 0002-8614. 66(3), p. 553–558. doi: 10.1111/jgs.15207. Full text in Research Archive Show summary

  Background/Objectives: Excess mortality after hip fracture is higher in men than in women. The objective was to study whether comorbidity differs in men and women with hip fracture and to what degree differences in comorbidity according to gender may explain the higher excess mortality in men. Results: Despite lower age (mean 78.7 vs 81.7), men had higher comorbidity than women. Compared with controls, women (hazard ratio (HR) = 6.5, 95% confidence interval (CI) = 6.2–6.9) and men (HR = 7.8, 95% CI = 7.3–8.3) with a CCI of 2 or greater were more likely to die. Women with a CCI of 2 or greater had an estimated 1‐year risk of dying of 44%, and controls had an 11% risk; men with a CCI of 2 or greater had an estimated risk of dying of 53%, and controls had a 12% risk. Men were twice as likely as women to die within 1 year (HR = 2.0, 95% CI = 1.9–2.1). When adjusting for comorbidity, the difference was only slightly smaller (HR = 1.8, 95% CI = 1.7–1.8). Conclusion: Men had greater comorbidity than women, but this did not explain the difference according to gender in excess mortality after hip fracture. Men who fracture a hip are an especially vulnerable subpopulation, even when there is no apparent comorbidity, and warrant special attention in follow‐up and care.

• Søgaard, Anne-Johanne; Ranhoff, Anette Hylen; Meyer, Haakon E; Omsland, Tone Kristin; Nystad, Wenche & Tell, Grethe S. [Show all 7 contributors for this article] (2018). The association between alcohol consumption and risk of hip fracture differs by age and gender in Cohort of Norway: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 29(11), p. 2457–2467. doi: 10.1007/s00198-018-4627-1. Full text in Research Archive Show summary

  Summary: The association between alcohol consumption and hip fracture differed by gender: Men aged 30–59 years drinking frequently or 14+ gl/week had higher risk than moderate drinkers. No significant association was seen in older men. Women not drinking alcohol had higher risk than those drinking moderately both regarding frequency and amount. Introduction: We aimed to examine alcohol consumption and risk of hip fracture according to age and gender in the population-based Cohort of Norway (1994–2003). Methods: Socio-demographics, lifestyle, and health were self-reported and weight and height were measured in 70,568 men and 71,357 women ≥ 30 years. Information on subsequent hip fractures was retrieved from hospitals’ electronic patient registries during 1994–2013. Frequency of alcohol consumption was categorized: never/seldom, moderate (≤ 2–3 times/week), or frequent (≥ 4 times/week), and amount as number of glasses per week: 0, 1–6, 7–13, 14–27, and 28+. Type of alcohol (wine vs. beer/hard liquor) was also examined. Cox’s proportional hazards regression was used to estimate hazard ratios (HRs) stratified on gender and baseline age < 60 and ≥ 60 years. Results: During median 15-year follow-up, 1558 men and 2511 women suffered a hip fracture. Using moderate drinkers as reference, men < 60 years drinking frequently had multivariable adjusted HR = 1.73 (CI 1.02–2.96) for hip fracture and more than 2.5 times higher risk if they consumed 14+ glasses compared to 1–6 glasses per week. In other groups of age and gender, no statistically significant increased risk was found in those consuming the highest levels of alcohol. Compared to women with moderate or frequent alcohol use, never/seldom-drinking women had the highest fracture risk. In women, use of wine was associated with lower fracture risk than other types of alcohol. Conclusions: Risk of hip fracture was highest in men < 60 years with the highest frequency and amount of alcohol consumption and in non-drinking women.

• Bhowmik, Bishwajit; Siddiquee, Tasnima; Mujumder, Anindita; Afsana, Faria; Ahmed, Tareen & Mdala, Ibrahimu [Show all 11 contributors for this article] (2018). Serum lipid profile and its association with diabetes and prediabetes in a rural Bangladeshi population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 15(9). doi: 10.3390/ijerph15091944. Full text in Research Archive Show summary

  Dyslipidemia is commonly associated with diabetes (T2DM). This has been demonstrated for the Caucasian population, but few data are available for Asian Indians. The paper aims to investigate serum lipids (separately or in combination) and their association with glucose intolerance status (T2DM and prediabetes) in a rural Bangladeshi population. A sample of 2293 adults (≥20 years) were included in a community based cross-sectional survey in 2009. Anthropometric measures, blood pressure, blood glucose (fasting and 2-h oral glucose tolerance test) and fasting serum lipids (total cholesterol, T-Chol; triglycerides, Tg; low density lipoprotein cholesterol, LDL-C and high density lipoprotein cholesterol, HDL-C) were registered. Analysis of covariance (ANCOVA) and regression analysis were performed. High Tg levels were seen in 26% to 64% of the participants, depending on glucose tolerance status. Low HDL-C levels were seen in all groups (>90%). Significant linear trends were observed for high T-Chol, high Tg and low HDL-C with increasing glucose intolerance (p for trend <0.001). T2DM was significantly associated with high T-Chol (Odds ratio (OR): 2.43, p < 0.001), high Tg (OR: 3.91, p < 0.001) and low HDL-C (OR: 2.17, p = 0.044). Prediabetes showed a significant association with high Tg (OR: 1.96, p < 0.001) and low HDL-C (OR: 2.93, p = 0.011). Participants with combined high Tg and low HDL-C levels had a 12.75-fold higher OR for T2DM and 4.89 OR for prediabetes. In Asian Indian populations an assessment of serum lipids is warranted not only for T2DM patients, but also for those with prediabetes.

• Andreasen, Camilla; Solberg, Lene Bergendal; Basso, Trude; Borgen, Tove Tveitan; Dahl, Cecilie & Wisløff, Torbjørn [Show all 20 contributors for this article] (2018). Effect of a Fracture Liaison Service on the Rate of Subsequent Fracture Among Patients With a Fragility Fracture in the Norwegian Capture the Fracture Initiative (NoFRACT): A Trial Protocol. JAMA Network Open. 1(8). doi: 10.1001/jamanetworkopen.2018.5701. Full text in Research Archive Show summary

  Importance Fragility fracture is a major health issue because of the accompanying morbidity, mortality, and financial cost. Despite the high cost to society and personal cost to affected individuals, secondary fracture prevention is suboptimal in Norway, mainly because most patients with osteoporotic fractures do not receive treatment with antiosteoporotic drugs after fracture repair. Objectives To improve secondary fracture prevention by introducing a standardized intervention program and to investigate the effect of the program on the rate of subsequent fractures. Design, Setting, and Participants Trial protocol of the Norwegian Capture the Fracture Initiative (NoFRACT), an ongoing, stepped wedge cluster randomized clinical trial in 7 hospitals in Norway. The participating hospitals were cluster randomized to an intervention starting date: May 1, 2015; September 1, 2015; and January 1, 2016. Follow-up is through December 31, 2019. The outcome data were merged from national registries of women and men 50 years and older with a recent fragility fracture treated at 1 of the 7 hospitals. Discussion The NoFRACT trial is intended to enroll 82 000 patients (intervention period, 26 000 patients; control period, 56 000 patients), of whom 23 578 are currently enrolled by January 2018. Interventions include a standardized program for identification, assessment, and treatment of osteoporosis in patients with a fragility fracture that is led by a trained coordinating nurse. The primary outcome is rate of subsequent fracture (per 10 000 person-years) based on national registry data. Outcomes before (2008-2015; control period) and after (2015-2019; intervention period) the intervention will be compared, and each hospital will act as its own control. Use of outcomes from national registry data means that all patients are included in the analysis regardless of whether they are exposed to the intervention (intention to treat). A sensitivity analysis with a transition window will be performed to mitigate possible within-cluster contamination. Results Results are planned to be disseminated through publications in peer-reviewed journals and presented at local, national, and international conferences. Conclusions By introducing a standardized intervention program for assessment and treatment of osteoporosis in patients with fragility fractures, we expect to document reduced rates of subsequent fractures and fracture-related mortality.

• Lopez, Maria Garcia; Baron, John A.; Omsland, Tone Kristin; Søgaard, Anne-Johanne & Meyer, Haakon E (2018). Homocysteine‐Lowering Treatment and the Risk of Fracture: Secondary Analysis of a Randomized Controlled Trial and an Updated Meta‐Analysis. JBMR Plus. 2(5), p. 295–303. doi: 10.1002/jbm4.10045. Full text in Research Archive
• Søgaard, Anne-Johanne; Holvik, Kristin; Omsland, Tone Kristin; Tell, Grethe Seppola; Dahl, Cecilie & Schei, Berit [Show all 7 contributors for this article] (2016). Age and Sex Differences in Body Mass Index as a Predictor of Hip Fracture: A NOREPOS Study. American Journal of Epidemiology. ISSN 0002-9262. 184(7), p. 510–519. doi: 10.1093/aje/kww011. Full text in Research Archive
• Søgaard, Anne-Johanne; Holvik, Kristin; Meyer, Haakon E; Tell, Grethe Seppola; Gjesdal, Clara Gram & Emaus, Nina [Show all 10 contributors for this article] (2016). Continued decline in hip fracture incidence in Norway: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 27(7), p. 2217–2222. doi: 10.1007/s00198-016-3516-8. Full text in Research Archive
• Solbakken, Siri Marie; Meyer, Haakon E; Stigum, Hein; Søgaard, Anne-Johanne; Holvik, Kristin & Magnus, Jeanette H. [Show all 7 contributors for this article] (2016). Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study. Osteoporosis International. ISSN 0937-941X. 28(3), p. 881–887. doi: 10.1007/s00198-016-3795-0. Full text in Research Archive
• Lopez, Maria Garcia; Omsland, Tone Kristin; Søgaard, Anne-Johanne & Meyer, Haakon E (2015). Self-perceived memory loss is associated with an increased risk of hip fracture in the elderly: a population-based NOREPOS cohort study. BMC Geriatrics. 15. doi: 10.1186/s12877-015-0135-8. Full text in Research Archive Show summary

  Background An early detection of memory loss may hold great value as a predictor for dementia. Dementia has already been associated with higher risk of hip fracture. Our aim was to examine the prospective association between self-reported memory-loss and the risk of subsequent hip fracture in the elderly. Methods A population-based prospective cohort study design was used. Information on four self-perceived memory loss questions was obtained from questionnaires in 3 health surveys performed in Norway during the years 2000–2001. A total of 7154 men and 2462 women aged 67–77 years old were followed for a median of 7.8 years. Hip fracture information (n = 287 in men, and n = 237 in women) was obtained from NORHip (a database including all hip fractures treated in Norway from year 1994). Cox survival analysis was performed to estimate HR (hazard ratio). Results The risk of sustaining a hip fracture were higher in those who reported to forget things they had just heard or read, with a HR of 1.52 (1.19--1.95) in men and HR 1.60 (1.23--2.07) in women after adjustment for relevant confounders. Women reporting to forget where they had put things also had higher risk of later hip fracture with a HR of 1.58 (1.20--2.07). Answering yes in both questions showed stronger association with sustaining a first hip fracture compared with those who gave a negative response in both questions, with a multivariate adjusted HR of 1.41 (IC 95 % 1.06--1.88) in men and 1.90 (IC 95 % 1.39--2.60) in women. The two last questions did not show a significant association with hip fracture. Conclusions There was a higher risk of hip fracture in elderly who reported self-perceived memory loss. Due to the serious implications of sustaining a hip fracture, early detection of risk groups is important for preventive interventions.

• Omsland, Tone Kristin; Eisman, John A.; Næss, Øyvind; Center, Jacqueline R; Gjesdal, Clara Gram & Tell, Grethe Seppola [Show all 13 contributors for this article] (2015). Educational inequalities in post-hip fracture mortality: a NOREPOS studys. Journal of Bone and Mineral Research. ISSN 0884-0431. 30(12), p. 2221–2228. doi: 10.1002/jbmr.2579. Full text in Research Archive Show summary

  Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality.

• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe Seppola; Forsen, Lisa; Flaten, Trond Peder & Hongve, Dag [Show all 10 contributors for this article] (2015). Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study. Bone. ISSN 8756-3282. 81, p. 292–299. doi: 10.1016/j.bone.2015.07.020. Full text in Research Archive
• Søgaard, Anne-Johanne; Holvik, Kristin; Omsland, Tone Kristin; Tell, Grethe S; Dahl, Cecilie & Schei, Berit [Show all 9 contributors for this article] (2015). Abdominal obesity increases the risk of hip fracture. A population-based study of 43 000 women and men aged 60-79 years followed for 8 years. Cohort of Norway. Journal of Internal Medicine. ISSN 0954-6820. 277(3), p. 306–317. doi: 10.1111/joim.12230. Full text in Research Archive
• Omsland, Tone Kristin; Emaus, Nina; Tell, Grethe Seppola; Magnus, Jeanette H.; Ahmed, Luai Awad & Holvik, Kristin [Show all 16 contributors for this article] (2014). Mortality following the first hip fracture in Norwegian women and men (1999-2008): A NOREPOS study. Bone. ISSN 8756-3282. 63, p. 81–86. doi: 10.1016/j.bone.2014.02.016. Full text in Research Archive
• Omsland, Tone Kristin & Magnus, Jeanette H. (2014). Forecasting the burden of future postmenopausal hip fractures. Osteoporosis International. ISSN 0937-941X. 25(10), p. 2493–2496. doi: 10.1007/s00198-014-2781-7. Full text in Research Archive
• Solbakken, Siri Marie; Magnus, Jeanette H.; Meyer, Haakon E; Emaus, Nina; Tell, Grethe Seppola & Holvik, Kristin [Show all 11 contributors for this article] (2014). Impact of comorbidity, age, and gender on seasonal variation in hip fracture incidence. A NOREPOS study. Archives of Osteoporosis. ISSN 1862-3522. 9. doi: 10.1007/s11657-014-0191-2. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2014). Do cadmium, lead, and aluminum in drinking water increase the risk of hip fractures? A NOREPOS study. Biological Trace Element Research. ISSN 0163-4984. 157(1), p. 14–23. doi: 10.1007/s12011-013-9862-x. Full text in Research Archive
• Ahmed, Luai Awad; Center, JR; Bjørnerem, Åshild; Bluic, Dana; Joakimsen, Ragnar Martin & Jørgensen, Lone [Show all 15 contributors for this article] (2013). Progressively increasing fracture risk with advancing age after initial incident fragility fracture: The Tromsø Study. Journal of Bone and Mineral Research. ISSN 0884-0431. 28(10), p. 2214–2221. doi: 10.1002/jbmr.1952. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2013). Nationwide data on municipal drinking water and hip fracture: Could calcium and magnesium be protective? A NOREPOS study. Bone. ISSN 8756-3282. 57(1), p. 84–91. doi: 10.1016/j.bone.2013.06.017. Full text in Research Archive
• Omsland, Tone Kristin; Emaus, Nina; Tell, Grethe S; Ahmed, Luai Awad; Center, Jacqueline R & Nguyen, Nyuyen D [Show all 11 contributors for this article] (2013). Ten-year risk of second hip fracture. A NOREPOS study. Bone. ISSN 8756-3282. 52(1), p. 493–497. doi: 10.1016/j.bone.2012.09.009. Full text in Research Archive
• Omsland, Tone Kristin; Holvik, Kristin; Meyer, Haakon E; Center, Jacqueline; Emaus, Nina & Tell, Grethe S [Show all 13 contributors for this article] (2012). Hip fractures in Norway 1999-2008: time trends in total incidence and second hip fracture rates. A NOREPOS study. European Journal of Epidemiology (EJE). ISSN 0393-2990. 27(10), p. 807–814. doi: 10.1007/s10654-012-9711-9. Full text in Research Archive
• Omsland, Tone Kristin; Ahmed, Luai; Grønskag, Anna Brenne; Schei, Berit; Emaus, Nina & Langhammer, Arnulf [Show all 11 contributors for this article] (2011). More forearm fractures among urban than rural women: The NOREPOS study based on the Tromsø study and the HUNT study. Journal of Bone and Mineral Research. ISSN 0884-0431. 26(4), p. 850–856. doi: 10.1002/jbmr.280. Full text in Research Archive
• Wilsgaard, Tom; Emaus, Nina; Ahmed, Luai; Grimnes, Guri; Joakimsen, Ragnar M & Omsland, Tone Kristin [Show all 8 contributors for this article] (2009). Lifestyle Impact on Lifetime Bone Loss in Women and Men. American Journal of Epidemiology. ISSN 0002-9262. 169(7), p. 877–886. doi: 10.1093/aje/kwn407. Full text in Research Archive
• Omsland, TK; Gjesdal, Clara G; Emaus, Nina; Tell, Grethe S.; Tell, Grethe Seppola & Meyer, Haakon (2009). Regional differences in hip bone mineral density levels in Norway: the NOREPOS study. Osteoporosis International. ISSN 0937-941X. 20(4), p. 631–638. doi: 10.1007/s00198-008-0699-7. Full text in Research Archive
• Emaus, Nina; Omsland, TK; Ahmed, Luai; Grimnes, Guri; Sneve, Monica & Berntsen, Gro (2009). Bone mineral density at the hip in Norwegian women and men-prevalence of osteoporosis depends on chosen references: the Tromso Study. European Journal of Epidemiology (EJE). ISSN 0393-2990. 24(6), p. 321–328. doi: 10.1007/s10654-009-9333-z. Full text in Research Archive
• Omsland, TK; Schei, B; Grønskag, AB; Langhammer, A; Forsen, Lisa & Gjesdal, CG [Show all 7 contributors for this article] (2009). Weight loss and distal forearm fractures in postmenopausal women. Osteoporosis International. ISSN 0937-941X. 20(12), p. 2009–2016. doi: 10.1007/s00198-009-0894-1. Full text in Research Archive
• Omsland, Tone K; Emaus, Nina; Gjesdal, Clara G; Falch, Jan A; Tell, Grethe S & Forsen, Lisa [Show all 8 contributors for this article] (2008). In vivo and in vitro comparison of densitometers in the NOREPOS study. Journal of clinical densitometry. ISSN 1094-6950. 11(2), p. 276–282. doi: 10.1016/j.jocd.2007.10.001. Full text in Research Archive
• Omsland, Tone Kristin; Gjesdal, Clara Gram; Emaus, Nina; Falch, Jan Arvid; Tell, Grethe S & Meyer, HE (2008). Regional differences in hip bone mineral density levels in Norway. The NOREPOS Study. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-008-0699-7. Full text in Research Archive
• Gharagzlian, Sedegheh; Borrebæk, Jørgen; Henriksen, Tore; Omsland, Tone Kristin; Shegarfi, Hamid & Kolset, Svein Olav (2006). Effect of hyperglycemic condition on proteoglycan secretion in cultured human endothelial cells. European Journal of Nutrition. ISSN 1436-6207. 45(7), p. 369–375. Full text in Research Archive

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• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2025). Incidence of proximal humerus fracture varies by country of origin and marital status. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 33(Suppl.1), p. 13–13. doi: https:/www.ntnu.no/ojs/index.php/norepid/index. Full text in Research Archive
• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2025). Incidence of proximal humerus fracture among older adults in Oslo, Norway varies by country background and marital status. Full text in Research Archive
• Kjeldgaard, Helena Kames; Omsland, Tone Kristin; Skirbekk, Vegard Fykse; O'Flaherty, Martin; Meyer, Haakon Eduard & Holvik, Kristin (2024). Forecasting the burden of hip fracture in Norway towards 2050 by educational level. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 32, p. 21–21. Full text in Research Archive
• Holvik, Kristin; Søgaard, Anne-Johanne; Dahl, Cecilie; Meyer, Haakon Eduard & Omsland, Tone Kristin (2024). Osteoporose er et oversett folkehelseproblem. Sykepleien Forskning. ISSN 1890-2936. 112(4), p. 10–16. doi: 10.4220/Sykepleiens.2024.96065. Full text in Research Archive Show summary

  Mange mennesker lever med uoppdaget osteoporose. Årsaken er at tilstanden ofte ikke gir symptomer før et brudd oppstår. Et første brudd etter fylte 50 år er et vanlig tegn på økt risiko for ytterligere brudd, som kan få alvorlige konsekvenser. Selv om det finnes effektiv, trygg og rimelig forebyggende behandling, er det kun et mindretall av pasientene med høy bruddrisiko som benytter seg av tilbudet. Tilstrekkelig ernæring og regelmessig fysisk aktivitet er også viktige faktorer for å forebygge osteoporose.

• Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2023). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture. A nationwide NOREPOS cohort study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 31(1), p. 19–19. Full text in Research Archive
• Holvik, Kristin; Dahl, Cecilie; Søgaard, Anne-Johanne; Solbakken, Siri Marie; Tell, Grethe Seppola & Hoff, Mari [Show all 12 contributors for this article] (2023). Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 31(1), p. 22–22. Full text in Research Archive
• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 20 contributors for this article] (2023). Fracture Liaison Services and Subsequent Fracture Risk: a multicenter, pragmatic, Stepped-Wedge Cluster-Randomized controlled trial. Full text in Research Archive
• Riska, Brit Solvor Lyse; Holvik, Kristin; Gunnes, Nina; Omsland, Tone Kristin; Stigum, Hein & Meyer, Haakon Eduard [Show all 7 contributors for this article] (2022). Risk of hip fracture in Norwegians using anti-osteoporosis medication. Full text in Research Archive Show summary

  Introduction: Norway has a high hip fracture incidence. Clinical trials have demonstrated fracture-preventive effects of bisphosphonates (BPs) and denosumab (DMab). We aimed to investigate whether BPs and DMab used in the population of Norway reduce risk of first-time hip fracture when adjusting for morbidity. Material and methods: Demographic information from participants in the Population and Housing Census 2001 who were alive and resident by 1 January 2005 was linked with filled prescriptions in the Norwegian prescription database (2005-2016) and the NOREPOS hip fracture database. Persons 50 years and older were included starting from January 2005 and observed through December 2016. Sex-stratified time-to-event analysis was used with age as time scale and time-varying exposure to BPs and DMab. The medication-based Rx-Risk Comorbidity Index was added as a time-varying covariate. Other covariates were marital status, education, and exposure to BPs/DMab with another indication than osteoporosis. Results: Of 1,044,661 women and 1,040,782 men, 74,775 (7.2%) and 13,417 (1.3%), respectively, were ever-users. Age-adjusted hazard ratio (HR) of hip fracture in women was 1.20 (95 % CI: 1.15–1.26) when using BPs, and HR 0.74 (0.55–0.99) when using DMab. Fully adjusted HRs were 1.01 (0.96–1.06) and 0.62 (0.46–0.83) respectively. For men exposed to BPs, HR was well above 1 – also when adjusted. Conclusions: In population-wide real-world data, women exposed to BPs had a hip fracture risk around the same level as the unexposed population after adjusting for comorbidity. Exposure to DMab was associated with a lower risk of hip fracture in women.

• Riska, Brit Solvor Lyse; Gunnes, Nina; Meyer, Haakon Eduard; Finnes, Trine Elisabeth; Omsland, Tone Kristin & Stigum, Hein [Show all 7 contributors for this article] (2022). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture – a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Full text in Research Archive
• Riska, Brit Solvor Lyse; Gunnes, Nina; Stigum, Hein; Finnes, Trine Elisabeth; Meyer, Haakon Eduard & Omsland, Tone Kristin [Show all 7 contributors for this article] (2022). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture – a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 30(1), p. 19–19. Full text in Research Archive Show summary

  Introduction: Norway has a high hip fracture incidence. Bisphosphonates and denosumab have been shown to prevent hip fractures in clinical trials, but there is a lack of population studies. Aims: To investigate whether use of bisphosphonates and denosumab reduce the risk of first-time hip fracture in Norway when adjusting for morbidity by the medication-based Rx-Risk Comorbidity index. Methods: The population was defined as inhabitants identified in the national census of 2001 who were still alive and resident by 1 January 2005. The Norwegian prescription database (NorPD) supplied data on exposures to bisphosphonates, denosumab, and other drugs for the calculation of the Rx-Risk score. Information on previous and incident hip fracture was available in the quality-assured NOREPOS hip fracture database. Persons 50 years or older were included starting from January 2005 and observed through December 2016. Sex-stratified Cox regression and flexible parametric survival analysis was used with age as time scale and with time-varying exposure to bisphosphonates and denosumab. Individuals were followed until hip fracture or censoring (death, emigration, age 90 years, or 31 December 2016, whichever occurred first). Rx-Risk score was included as a time-varying covariate, updated every two years. Other covariates were marital status, education, and time-varying use of bisphosphonates/denosumab with another indication than osteoporosis. Mean time to hip fracture within the observation period (restricted mean survival time) was estimated for the two different treatment exposures. Results: Of 1,044,661 women and 1,040,782 men, 74,775 (7.2%) and 13,417 (1.3%), respectively, were ever-exposed to either drug. Women exposed to bisphosphonates had a hazard ratio (HR) of 1.09 (95% CI: 1.05–1.13) for hip fracture (age as time-scale), while women exposed to denosumab had an HR of 0.68 (95% CI: 0.53–0.87). The corresponding fully adjusted HRs were 0.95 (95% CI: 0.91–0.99) and 0.58 (95% CI: 0.46–0.74) respectively. Exposure to either of the two drugs gave a longer hip fracture free period in women. For men exposed to either drug, the HRs was well above 1 – also when adjusted. Conclusions: In population-wide real-world data, women exposed to bisphosphonates had a hip fracture risk around the same level as the unexposed population after adjusting for comorbidity. Exposure to denosumab was associated with a lower risk of hip fracture in women.

• Søgaard, Anne-Johanne; Holvik, Kristin; Dahl, Cecilie; Meyer, Haakon Eduard & Omsland, Tone Kristin (2021). Osteoporose – den glemte folkesykdom. Michael. ISSN 1893-9651. 18(28), p. 119–133. Full text in Research Archive Show summary

  Osteoporose innebærer at benvevet blir mer porøst og kan brekke ved lav belastning. Svekkelsen i benstrukturen gir ingen symptomer før man får et brudd. Det er usikkert hvor mange som har osteoporose i Norge, men antallet er beregnet å være nærmere 300 000 personer. Ofte benyttes osteoporotiske brudd i hofte, underarm og ryggrad som mål på forekomst av osteoporose som klinisk problem. Hoftebrudd har ofte størst konsekvenser for enkeltindivid og samfunn. Det skjer et hoftebrudd hver time på døgnet i Norge, totalt ca. 9 000 per år. Kvinner og eldre er mest utsatt. Norge ligger på verdenstoppen i hoftebrudd, og vi har begrenset kunnskap om årsakene til dette. Et hoftebrudd koster nesten 1 million kroner det første året. Selv om hyppigheten har gått ned siden begynnelsen av 1990-årene, vil antall hoftebrudd likevel øke fremover pga. økende antall eldre. Osteoporose og fall er de viktigste risikofaktorene, og røyking, lav vekt, lite fysisk aktivitet og tidligere brudd, virker inn på disse. Vi omtaler her et pågående prosjekt i Oslo som følger opp fallskader for å hindre nye fall, og et omfattende prosjekt ved syv sykehus som skal forebygge nye brudd hos bruddpasienter. Vi spør også hvorfor det tilsynelatende satses så lite på å forebygge denne folkesykdommen.

• Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon Eduard; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Re: “Hip Fracture and Mortality: A Loss of Life Expectancy Interpretation” by Thao T Ho-Le and Tuan V Nguyen. Journal of Bone and Mineral Research. ISSN 0884-0431. doi: 10.1002/jbmr.4383. Full text in Research Archive
• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Holvik, Kristin & Meyer, Haakon E (2021). Cold – a risk factor for osteoporotic fractures and fracture related mortality. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 29(1), p. 30–30. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Brunborg, Cathrine; Andreasen, Camilla & Hübschle, Lars Michael [Show all 18 contributors for this article] (2019). Individuals with Central Fractures have More Prevalent Vertebral Fractures, Lower Trabecular Bone Score and Lower BMD than Individuals with Peripheral Fractures: a Sub-study of NoFRACT. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in improved adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Søgaard, Anne-Johanne; Omsland, Tone Kristin; Holvik, Kristin; Tell, Grethe S.; Dahl, Cecilie & Schei, Berit [Show all 7 contributors for this article] (2017). The Authors Reply. American Journal of Epidemiology. ISSN 0002-9262. 185(6), p. 511–513. doi: 10.1093/aje/kwx028. Full text in Research Archive
• Solberg, Lene Bergendal; Frihagen, Frede; Basso, Trude; Gjesdal, Clara Gram; Eriksen, Erik Fink & Nordsletten, Lars [Show all 12 contributors for this article] (2017). Updates on the Norwegian Capture the Fracture® Initiative (NoFRACT). Full text in Research Archive
• Andreasen, Camilla; Osima, Marit; Rognli, Veronica; Grundel, Dag; Elvenes, Jan & Knutsen, Gunnar [Show all 17 contributors for this article] (2017). Tromsoporosis - Adherence to a Secondary Fracture Prevention Program in Tromsø, Norway. Full text in Research Archive
• Holvik, Kristin; Meyer, Haakon E; Laake, Ida; Omsland, Tone Kristin & Søgaard, Anne-Johanne (2016). Milk intake in middle-aged Norwegians and risk of hip fracture: Is there an association? A linkage between the Norwegian Counties Study and the NOREPOS hip fracture database. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 26, p. 10–10. Full text in Research Archive
• Søgaard, Anne-Johanne; Ranhoff, Anette Hylen; Meyer, Haakon E; Omsland, Tone Kristin; Nystad, Wenche & Holvik, Kristin (2016). Frequent alcohol consumption increases risk of hip fracture in men below 60 years in Cohort of Norway. A NOREPOS study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 26, p. 10–10. Full text in Research Archive
• Holvik, Kristin; Meyer, Haakon E; Laake, Ida; Omsland, Tone Kristin & Søgaard, Anne-Johanne (2016). Milk intake in middle-aged Norwegians and risk of hip fracture: Is there an association? A linkage between the Norwegian Counties Study and the NOREPOS hip fracture database. Food & Nutrition Research (FNR). ISSN 1654-6628. 60, p. 31961–31961. doi: 10.3402/fnr.v60.31961. Full text in Research Archive
• Søgaard, Anne-Johanne; Omsland, Tone Kristin; Holvik, Kristin; Tell, Grethe Seppola; Dahl, Cecilie & Schei, Berit [Show all 7 contributors for this article] (2015). Low body mass index (BMI) as predictor of hip fracture differs by age and gender in Cohort Norway. A NOREPOS study. European Geriatric Medicine. ISSN 1878-7649. 6, p. S07–S07. Full text in Research Archive
• Lopez, Maria Garcia; Omsland, Tone Kristin; Søgaard, Anne-Johanne & Meyer, Haakon E (2015). Increased risk of hip fracture in people with self-perceived memory loss. A NOREPOS based prospective cohort study of 10449 individuals aged 67‐78 years. European Geriatric Medicine. ISSN 1878-7649. 6, p. S11–S11. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe Seppola; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2014). Is copper in drinking water related to risk of hip fracture? And could a possible protective associationbetween calcium and hip fracture be modified by copper? Norsk Epidemiologi. ISSN 0803-2491. 24, p. 48–48. Full text in Research Archive
• Omsland, Tone Kristin (2014). Hoftebrudd ingen bagatell. [Journal]. Dagbladet. Full text in Research Archive
• Solbakken, Siri Marie; Magnus, Jeanette H.; Meyer, Haakon E; Emaus, Nina; Tell, Grethe Seppola & Holvik, Kristin [Show all 11 contributors for this article] (2014). IMPACT OF SEASON AND COMORBIDITY ON HIP FRACTURE INCIDENCE. A NOREPOS STUDY. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 10 contributors for this article] (2013). Do cadmium and lead in drinking water increase the risk of hip fracture? A NOREPOS study. Full text in Research Archive
• Omsland, Tone Kristin; Emaus, Nina; Holvik, Kristin; Tell, Grethe S; Ahmed, Luai Awad & Center, Jackie [Show all 15 contributors for this article] (2013). GENDER DIFFERENCES IN ALL-CAUSE MORTALITY FOLLOWING FIRST HIP FRACTURE IN 81,867 NORWEGIAN WOMEN AND MEN: THE NORWEGIAN EPIDEMIOLOGIC OSTEOPOROSIS STUDIES. Osteoporosis International. ISSN 0937-941X. 24, p. S257–S257. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2012). Do toxic metals in municipal drinking water increase the risk of hip fractures? The NOREPOS study. Full text in Research Archive
• Søgaard, Anne-Johanne; Omsland, Tone Kristin & Meyer, Haakon E (2012). WHAT ARE THE ASSOCIATIONS BETWEEN WAIST HIP RATIO, BODY MASS INDEX AND HIP FRACTURES? COHORT OF NORWAY. Osteoporosis International. ISSN 0937-941X. 23, p. S526–S526. Full text in Research Archive
• Omsland, Tone Kristin; Holvik, Kristin; Emaus, Nina; Tell, Grethe S; Schei, Berit & Tverdal, Aage [Show all 11 contributors for this article] (2011). Hip fracture incidence in Norway 1999-2008. Norwegian Epidemiologic Osteoporosis Studies. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 21, p. 38–38. Full text in Research Archive
• Omsland, Tone Kristin; Ahmed, Luai A.; Grønskag, Anna Brenne; Schei, Berit; Emaus, Nina & Langhammer, Arnulf [Show all 11 contributors for this article] (2010). Urban-rural differences in forearm fractures in postmenopausal women - the norepos study. Osteoporosis International. ISSN 0937-941X. 21, p. 258–259. Full text in Research Archive
• Emaus, Nina; Omsland, Tone Kristin; Ahmed, Luai Awad; Grimnes, Guri; Sneve, Markus Handal & Berntsen, Gro (2009). BONE MINERAL DENSITY AND PREVALENCE OF OSTEOPOROSIS AT THE HIP IN WOMEN AND MEN AGED 30-85 YEARS - THE TROMSO STUDY. Osteoporosis International. ISSN 0937-941X. 20, p. 64–65. Full text in Research Archive
• Omsland, TK; Schei, B; Grønskag, Anna Brenne; Langhammer, A; Forsen, Lisa & Gjesdal, CG [Show all 7 contributors for this article] (2009). Weight loss and distal forearm fractures in women 65 years an older. Osteoporosis International. ISSN 0937-941X. 20, p. S264–S265. doi: 10.1007/s00198-009-0923-0. Full text in Research Archive
• Emaus, Nina; Omsland, TK; Ahmed, Luai; Grimnes, Guri; Grimnes, Geir & Sneve, Monica [Show all 7 contributors for this article] (2009). Bone mineral density at the hip in Norwegian women and men. Prevalence of osteoporosis depends on chosen references. The Tromso Study. Bone. ISSN 8756-3282. 44, p. S75–S75. doi: 10.1016/j.bone.2009.01.165. Full text in Research Archive
• Emaus, Nina; Wilsgaard, Tom; Ahmed, Luai; Grimnes, Guri; Joakimsen, Ragnar M & Omsland, TK [Show all 7 contributors for this article] (2009). Lifestyle impact on lifetime bone loss in women and men. The Tromso Study. Bone. ISSN 8756-3282. 44, p. S38–S38. doi: 10.1016/j.bone.2009.01.098. Full text in Research Archive
• Omsland, TK; Emaus, N; Gjesdal, Clara Gram; Falch, Jan Arvid; Tell, GS & Forsen, Lisa [Show all 8 contributors for this article] (2007). In vivo and in vitro comparison of DXA scanners. Journal of Bone and Mineral Research. ISSN 0884-0431. 22, p. S298–S298. Full text in Research Archive
• Eilertsen, Maja; Omsland, Tone Kristin; Nes, Ragnhild Bang & Czajkowski, Nikolai Olavi (2026). Biopsychosocial outcomes of wellbeing-promoting interventions: when life wears you down. Universitetet i Oslo. ISSN 9788234808890. Full text in Research Archive Show summary

  Wellbeing-promoting interventions may help counteract the effect of stress across biological, psychological, and social domains, although the underlying mechanisms remain incompletely understood. Situated within public health and health promotion research, this thesis explored the potential of such interventions to improve wellbeing, health, social connection, and work participation, particularly among adults facing health and social challenges. The first study was a systematic review and meta-analysis of 25 randomized controlled trials examining the effects of positive psychology interventions on biological markers of stress, including inflammatory biomarkers and cortisol. The findings indicated a modest but significant effect on inflammatory biomarkers, supporting the view that wellbeing interventions may positively influence biological processes. The second study evaluated the Five Ways to Wellbeing course among 373 participants in municipal health services. Participation was associated with sustained improvements in wellbeing, social connection, and self-rated health. Mental health outcomes improved more than in a comparable group of 524 individuals receiving Healthy Life Centre services. The third study was a randomized controlled trial of the Five Ways to Wellbeing course among 171 adults receiving support from NAV. Although recruitment difficulties and attrition limited statistical power and precluded firm conclusions regarding effectiveness, the study highlighted the challenges of conducting intervention research in welfare settings. Overall, the findings support the view that wellbeing is a modifiable resource that may strengthen resilience to stress across biological, psychological, and social domains. The thesis highlights the potential of wellbeing-promoting interventions to improve biological as well as psychological and social outcomes, while underscoring the need for pragmatic research designs that can be implemented in health and welfare services.

• Solbakken, Siri Marie & Omsland, Tone Kristin (2019). Hip fracture incidence and mortality: The impact of season, health status and urbanization. Universitetet i Oslo. ISSN 9788283775341. Full text in Research Archive

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